Auto and Homeowners Insurance quotes online from Douglas Associates Group.com
 
 
 
 
 
 
Commercial Liability Quote click for FAST commercial liability insurance Quote

Commercial Property Quote click for FAST commercial property insurance Quote

Commercial Auto Quote click for FAST commercial auto Quote

Workers Comp Quote click for FAST workers comp Quote

Auto Insurance Quote click for FAST Auto Quote

Homeowners Insurance click for FAST Louisiana homeowners insurance quote

Insuring Louisiana Residents & Businesses. Call 318-807-2900
 
On-Line Workers Comp
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: (Must be Louisiana)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again (for accuracy):
Phone:
Fax (optional):
 


Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type NONE)
 
List Claims & Amounts Paid
(If none, type NONE)
 
Years In Business:
 
Business type:
(proprietorship, corporation, etc.)
 


 
Underwriting Information:
 
Describe IN DETAIL,
Your Business Operations:
 
Payroll Class #1:
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
Payroll Class #2: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
Payroll Class #3: (if none, leave blank)
List Class Code # if you know it, and describe payroll class: Insert Annual Payroll in dollars for this
class here:
$
 
 
Send my quotation via: E-Mail Fax
Regular Mail

 
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Workers Compensation Quote NOW!


Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

Douglas and Associates Group, LLC 600 No. 3rd Street - Monroe, LA 7201 Phone: 318-807-2900 | Fax: 318-807-2903
Email Us Your Questions: Customer Service | Custom Web Site Design by Insurance-Web-Sales.com © 2008